Smooth muscle and endothelial cell function in the pathogenesis of atherosclerosis

Although clinical studies have been very useful in identifying factors that accelerate the development of atherosclerotic vascular disease, the pathogenesis of the vascular lesions remains unknown. Studies carried out in the last 10 years have shown that smooth muscle and endothelial cells of the vascular wall play a very important role in atherogenesis. It has become apparent that these cells are very active metabolically during the initiation and subsequent growth of the plaques, and that the materials that these cells produce and secrete are important in the composition and growth of the plaques. In addition, there are important interactions at the vessel wall-blood interface that involve endothelial cells, hemodynamic forces and many constituents of the blood, including platelets, lipoproteins, coagulation factors, fibrinolytic agents and leukocytes. In this article the numerous functions of both smooth muscle and endothelial cells are discussed and the effects of known atherogenic agents on these cellular functions are reviewed. Emphasis is placed on the important interactions that take place both within the vessel wall and at the vessel wall-blood interface. Understanding of the regulation of smooth muscle and endothelial cell function during the development and subsequent growth of fibrofatty plaques may be useful in designing appropriate therapeutic interventions to control atherosclerotic disease.